News and Notes

God save the Czar! A new AIDS czar -- or rather, czarina -- was installed
by President Clinton during a brief ceremony in the Roosevelt Room on April
7, replacing Eric Goosby, Acting Director of the Office of National AIDS
Policy, and succeeding former director Patsy Fleming. The new director --
the third since the office was created some four years ago -- is Sandra
Thurman, an Atlanta AIDS activist and a member of the president's AIDS
Advisory Council. Ms. Thurman, a native of Atlanta, was Executive Director
for AID Atlanta, the largest AIDS service group in the South, from 1988
until 1993, and directed a task force on child survival and development at
the Carter Center, also in Atlanta, from 1993 until last year. "My
door is open to her," said President Clinton in announcing the
appointment. "I've worked with her, and I can attest she tells it like it
is. She speaks the truth unvarnished. She won't hold back in this office."
Thurman took a leave of absence in 1992 from AID Atlanta to manage the
Georgia primary for Clinton and worked on his presidential campaign, at the
Democratic National Convention, and on the inaugural committee.

Bruce Reed, Assistant to the President for Domestic Policy, told the
presidential AIDS Advisory Council that Thurman's appointment "really
was the President's idea." He added that, for the first time, the
Office of National AIDS Policy will have an office "within the White
House complex." Acting Director Eric Goosby is expected to stay on as
Thurman's deputy, though staff expansion at the office is unclear. "We
are deeply aware of the responsibility that this administration has to all
Americans who are living with HIV and AIDS and to those all around the
world who turn to us for leadership and for hope," Ms. Thurman said
upon her appointment. Many argue that the first responsibility is to lift
the federal ban on needle exchange, which she has declined to say she would
recommend to the President, stressing instead the need to educate Congress
on the matter.

Community reaction to the appointment of Thurman, with her indisputable
front-line experience and access to the President, was fairly positive;
notable exceptions were those of Sean Strub, the Founder and Executive
Editor of POZ ("she's a hack"), and ACT UP/Washington ("the
third in a series of ineffective, no-name bureaucrats filling the AIDS Czar
position").

In a discovery that offers promise for innovative ways to treat AIDS in
the future, scientists at the Naval Medical Research Institute in Bethesda,
Maryland have found a way to genetically prevent CD4 cells from making a
key protein that allows HIV to invade the cells. Research conducted last
year found that the protein, CCR5, is used by HIV early in the course of
infection to link with CD4 cells prior to taking control of them; later,
after the virus mutates, HIV may link with another cellular protein, CXCR4,
to invade the cell. The Naval Medical Research Institute team, headed by
Dr. Carl H. June, reported in the journal Science on April 11 that they
were able to prevent CD4 cells, HIV's primary target in the human body,
from making CCR5. "Our work shows that you can artificially induce
[HIV] immunity by turning off the CCR5 gene in the nucleus of the
cell," Dr. June said.

Despite conflicting evidence about its effectiveness, the Food and Drug
Administration on April 4 approved the drug delavirdine, the first AIDS
drug made by Pharmacia & Upjohn. The drug, sold under the brand name
Rescriptor, is expected to hit the shelves in less than a month and is a
member of the drug class known as non-nucleoside reverse transcriptase
inhibitors, which are weaker than protease inhibitors.

Delavirdine must always be used in combination, though Pharmacia has not
yet studied it in combination with its stronger cousins, the protease
inhibitors. Last November, an FDA advisory panel deadlocked over whether or
not to approve the drug, owing to conflicting data. One study showed that
delavirdine taken with AZT modestly improved the immune systems of people
in early-stage infection and halved their viral load compared to AZT alone.
But a study of people with advanced HIV illness who took delavirdine with
ddI found that benefits lasted only 12 weeks. Although the drug's main side
effect is a skin rash, Pharmacia warned that it can raise plasma levels of
one protease inhibitor, indinavir, so patients taking that drug should
adjust their dosage. The wholesale price of the drug is a relatively
affordable $6.16 a day per patient, or $2,700 a year. "We believe
Rescriptor will be a valuable addition to the list of AIDS
medications," said William W. Freimuth, a clinical researcher for
Pharmacia. Let's hope that with more we'll be merrier.

Everyone knows it causes cancer, heart disease, respiratory problems,
premature wrinkling, stained teeth, fetid breath, a voice like Lauren
Bacall, implacable addiction, expulsion from all polite society, missed
planes, trains and buses, and a really nasty-smelling apartment, but now
there's even worse news about smoking. Women who are infected with HIV and
who smoke during pregnancy are more likely than those who don't smoke to
transmit the virus to their babies, according to a study reported in the
April issue of the Journal of Acquired Immune Deficiency Syndromes and
Human Retrovirology.

Conducted by researchers at Thomas Jefferson University and the New York
State Health Department, thestudy found that one-third of participating
women who smoked and who did not take anti-viral drugs passed HIV to their
child. The usual risk of mother-to-fetus transmission is one in four,
although this can be reduced to one in ten when the mother takes AZT or
other antiviral drugs.

Ever wonder what makes some people tick? If we knew the answer to that
question, the world might be a better -- and safer -- place to live. Take
the case of a former assistant manager in the viral testing laboratory at
the New York Blood Center, for example. This individual, Eliazar Maniago,
36, of Bergenfield, New Jersey, was arrested on March 31 for -- are you
ready for this? -- allegedly manipulating testing for viruses like HIV and
hepatitis during a three-year period from 1993 to 1996. The New York Blood
Center is the nation's largest independent supplier of blood, providing 80
percent of the blood supply in the New York metro area in addition to blood
donor testing services for facilities in New Jersey, Pennsylvania and
Tennessee.

The New York Blood Center also imports and exports blood products to and
from Europe. In the complaint against Mr. Maniago an FDA expert said that
the manipulations undermine the reliability of the blood tests.

New York may be the city that never sleeps, but San Francisco is the place
to go the morning after you think you've been exposed to HIV. The city by
the bay will be the first in the nation to open clinics that offer
immediate anti-HIV treatment to prevent HIV infection for anyone who thinks
he or she was infected through unsafe sex or needle sharing. Operating at
three sites -- San Francisco General Hospital, South of Market and the
Tenderloin -- the clinics, scheduled to open in May or June, will offer 3TC
and AZT, plus counseling, for 28 days. The price for the "morning
after" treatment: $300. Protease inhibitors will be added for some --
for another $300. A battery of blood tests will boost your bill another
$200. The "morning after" treatment will actually take as many as
seven visits to complete. The counseling, presumably covered by the cost of
the drugs and blood tests, covers issues of self-esteem, depression,
substance abuse and negotiating safer sex.
"In this, like in many things in AIDS, we'll be the first," said
Dr. Mitchell Katz of San Francisco's Department of Public Health. He and
other experts say that the treatment doesn't guarantee protection and that
people should keep practicing safer sex, though adding that instant
treatment might prevent some of the 900 infections that take place in San
Francisco each year. The goal of the new clinics is to begin anti-HIV
treatment within hours of infection to prevent the virus from taking over
the cellular machinery of CD4 cells. Research in health care workers who
have been infected by accidental needle sticks has shown that immediate
administration of AZT decreased chances of infection by 79 percent. San
Francisco's aggressive approach to treating presumptive HIV infection is a
demonstration project, funded in part by the National Institutes of Health.

Let's end on a good note, shall we? Owing to effective public health
measures, the number of new tuberculosis cases in the United States
declined for the fourth year in a row, signaling that the disease is once
again under control.
According to announcements made on March 24 -- appropriately designated
World TB Day -- the national total for 1996, 21,300 new cases, was down by
1,533 from the prior year--a seven percent reduction from 1995 and a steady
decline from the TB "peak" of 1992. Tuberculosis was thought to
be eliminated in the 1940s, but it had a strong resurgence in the 1980s,
possibly as a result of the AIDS epidemic. The current decline is thought
to be due largely to "directly observed therapy," which involves
ensuring patients take their medication according to schedule by having
them come to clinics daily or visiting them in their homes. Despite the
decline in our country, TB is still the leading infectious killer of youth
and adults worldwide. The World Health Organization marked World TB Day by
saying this "is not a time for celebration, as the effective tools and
medicines discovered long ago to fight TB are still not being put to proper
use." Okay, we won't uncork the champagne -- yet -- but Americans with HIV,
for whom TB is a particular threat, can still heave a welcome sigh of
relief -- and maybe breathe a bit more freely.

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